Cardiovascular disease (CVD) is the leading cause of death for women in the United States, claiming more lives each year than all cancers combined. CVD and coronary heart disease (CHD) morbidity and mortality rates are significantly higher in African American (AA) women than in white women. Health care sites are excellent settings in which to counsel individuals regarding CVD risk reduction. Few studies to date, however, have tested the effectiveness of health care-based interventions with AA women or financially disadvantaged populations. The overall goal of this study, the Heart Healthy and Ethnically Relevant (HHER) Lifestyle Program, is to advance our understanding of how to effectively promote CVD risk reduction in health care settings among financially disadvantaged AA women ages 35 years and older. The proposed randomized clinical trial builds on recently completed formative and feasibility studies conducted by the investigators. We propose to train primary care providers to deliver brief tailored [based on the Transtheoretical Model (TTM)] behavioral counseling with nurse assisted goal setting. Patients of providers will be randomly assigned to intervention or standard care. Patients in the intervention condition (n=156) will receive a comprehensive, theory-based intervention that includes tailored provider-delivered counseling and goal-setting at baseline and at routine clinic visits, a community resource guide, a monthly newsletter and monthly telephone counseling. The standard care condition (n=156) will receive tailored provider-delivered counseling and goal-setting at baseline with generic health education materials on diet and PA and a community resource guide. A social ecological model will be used to conceptualize the intervention, and social cognitive theory and the TTM will guide the intervention targets and techniques. Participants will be assessed at baseline, 6, and 12 months. The primary outcomes are minutes per week of moderate intensity PA and dietary fat intake. The secondary outcomes are body weight and blood cholesterol. As a secondary aim, we also propose to examine the role of constructs consistent with SCT, social ecological models, and the TTM in mediating change in PA and diet.